What does hypertension care evaluation include?

The actual effect of blood pressure control, compliance with long-term intervention, patient quality of life, and complications prevention and control trends are not rigid process-based scoring.

Take Aunt Zhang, who just completed the quarterly follow-up visit at our community health service center last week. She has a 12-year history of essential hypertension, and she always missed taking antihypertensive medicine during the last quarterly follow-up visit. We adjusted her care plan, added a detachable timed pill box, and made an appointment with her daughter to remind her to measure her blood pressure during a video every night. This time for the nursing evaluation, the first thing to check is her home blood pressure register for this month to see if the average blood pressure is stable within the standard line of 130/80mmHg. It can also be mentioned here that there are still some differences in the acceptance standards of blood pressure measurement in the industry: specialist nursing in tertiary hospitals tend to use the results of three measurements in the clinic on different days as the standard. Our primary care care prefers to combine the average value of ambulatory blood pressure monitoring and home self-testing. After all, patients spend 90% of the time outside the hospital, and the stability of daily blood pressure is of higher reference value than the occasional clinic value.

However, it is not enough to just look at the blood pressure value. If the patient takes medicine suddenly and starves for two days to lower the blood pressure, the standard will not be maintained for long. So the next step depends on the actual implementation of the intervention measures. For example, we mentioned to Aunt Zhang that her daily salt intake should not exceed 5g and she should do moderate-intensity exercise for more than half an hour at least three times a week. We will not just listen to her own words of "done it", but will also ask her family members whether they have been doing well at home recently. Did she use low-sodium salt? Did she use a salt-limited spoon when cooking? Did she appear in the square dance team downstairs recently? This is like refilling a leaky bucket. You can't just look at how much water is in the bucket now. You have to first see if the leaking hole has been filled, otherwise all the water will leak out. There is also a very common controversy here. Some nursing evaluation standards are very strict, and patients are not allowed to touch any pickled products or high-sugar foods. After doing primary care for a long time, we feel that as long as the overall blood pressure can reach the standard, occasionally letting the elderly eat a piece of their favorite sauce meat and drink half a cup of sugar water can change their mood. In fact, it is more conducive to long-term control than strict control until the patient is depressed every day.

In addition to these visible indicators, there is another evaluation dimension that is easily overlooked, which is the patient's self-management ability and psychological state. There used to be a 68-year-old elder brother in our jurisdiction. Because he was afraid of having a stroke, he strictly controlled his diet, took medicine, and exercised as required. As a result, he became nervous. He felt like he was going to have a cerebral infarction when he was slightly dizzy. He couldn't sleep well for half a month, and his blood pressure jumped to 160/100mmH. g. In this case, even if the blood pressure is lowered by taking medicine, the nursing evaluation will not be qualified - after all, the purpose of our nursing is not to make patients become "ascetics" controlled by the disease, but to let them learn to coexist peacefully with high blood pressure, how to live their lives, and to minimize risks.

In fact, to put it bluntly, nursing evaluation is never intended to give patients or nursing staff a score. In essence, it is to check the last nursing plan one by one, keep those that are useful, and quickly adjust those that are not in line with the patient's actual situation. The ultimate goal is to enable patients to steadily control their blood pressure and avoid complications such as cerebral hemorrhage and renal failure.